Preventing Alzheimer's: A Holistic Approach to Improving Cognition, with Dr. Heather Sandison

There is not a pharmaceutical solution. And sometimes we'll see for three months or so, people will get a little bit better. But five years later, people who got on those medications did worse than people who never started them. They don't help long term.

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Hello and welcome back to the Feel Freaking Amazing podcast. I'm Wendy Trubo. This is my host, Ed Levitan. And I'm so excited to be interviewing our guest today. She's a colleague and a friend of mine. It's Dr. Heather Sandison. She is a distinguished naturopathic doctor. She's devoted her career to providing compassionate care and innovative solutions to those affected by dementia. She's renowned for her pioneering work. She's integrated groundbreaking holistic and multimodal interventions that seamlessly create clinical, residential, research, and educational platforms. It goes all together. She has been relentlessly dedicated to reversing Alzheimer's and actually has a book coming out. So her book launches on June 11. It is reversing Alzheimer's, the new toolkit to improve cognition and protect brain health. And so we're going to talk about that today because this is her zone of excellence. And, Heather, welcome to the show. I'm so excited. We're both excited, but since you and I are good friends, I'm, like, so excited to have you here and be able to get the word out about how to keep yourself healthy. So welcome.

Thank you. It's always a lot of fun when I get to hang out with you guys.

Totally. You have memory care sites called Nirama and you see this. Right. So can you talk about what you're doing there? Because I think it's fascinating. And you study this in your sites.

Yeah. So thank you. It's really exciting and really fun. What happened was in my clinical practice, I was seeing people come in with dementia, and many of them got better, and mostly the ones who didn't weren't able to do it. It's a lot. It's a lot to ask. And a lot of what's in my book is what we've learned from what we're doing at Marama, at the residential care facilities, that what we're trying to do is transform memory care into memory recovery. And just this past Monday, we had our first resident go home with a perfect MOCA score. She went home with a moca score of 30. She had been with us for six months. She had a moldy house. And so what she did was she decided she came on her birthday, it was her birthday gift to herself to come spend six months with us in this immersive experience where the foundations are taken care of for you. So it's an organic ketogenic diet, lots and lots of nutrient rich food, lots of veggies, and then there's a network of people that are doing the same thing. Their entire day is designed to be brain engaging. Whether it's activities that are creative or intellectually stimulating. There's, and there's animals and there's all kinds of things that are happening throughout the day. And then there's also vigorous exercise and plenty of it every day and that social connection between everyone else who's there. Plus it's a non toxic environment. We're hyper vigilant around mold, air filters, fresh air, also organic mattresses and bedding, and making sure that the air is non toxic. Right. The only smells you're getting are from the kitchen. There's no air fresheners, which you see a lot of in care. So in our community we really aim to spend the days they're designed to optimize cognitive function. And for her it was really fantastic. She came with a MOCA score that it wasn't too bad. It was in the mid-20s. But she went home with a much higher MOCA score and feeling ready to go back to her renovated house that no longer had mold.

Thank you. That was one of my things. Like please tell me she renovated the mold. But our listeners might not be aware of what the MOCA score is like. We know and actually one of the providers in our office does it. I was like, can you do this on my patient? So, but can you talk to people about what it is?

Because not everyone's aware the Montreal Cognitive Assessment is what a MOCA score is. And you might have heard presidents talking about this, referring to it, because it's a way to establish where you are on the spectrum. Now it doesn't pick up early cognitive decline, subjective cognitive decline when you're experiencing it, but as it gets more progressed, this is a great way for providers to communicate, for family members to communicate about where you are in the spectrum. So it's a one page worksheet where you draw a clock, you copy a cube, you follow some patterns do some math, math and identify some zoo animals. And it's out of 30. So a perfect score is 30 and 26 and above is normal. When you start to get down into the low 20s, this is measurable cognitive impairment. And we call it mild cognitive impairment. That's the diagnosis, but there's nothing mild about it. These are people who are struggling with their memory. Some are aware, some are not, but it's starting to impact their day to day life. Right. Maybe they're coping by writing everything down or they're just getting, you know, they're getting harassed by their children because they keep repeating the same things over and over again. And then as we get into the teens, particularly into the lower teens, 13, 14, 15, it starts to get more challenging to reverse this. That's why we want to catch it earlier. And then those single digit mochas are. People are reliant on others for activities of daily living. Cooking, dressing, sometimes toileting, going to the bathroom on their own, bathing and executive function that like, okay, I'm planning to do this and then I execute. That doesn't happen anymore.

Is the language still being used that dementia and Alzheimer's is essentially type 3 diabetes, is that still in use?

Yes. Yeah, you hear that kind of colloquially now. What? Whenever I see a paper, it's like, herpes causes dementia, or last weekend in Nature there was a publication that said APOE 44 is a cause of, is the cause of dementia or Alzheimer's. Now there's not one cause. And what works is when you say, okay, what's the blood sugar doing? Insulin. Is there insulin resistance? Is there glycotoxicity? Is there caramelization of the neurons happening? Because that blood sugar has been so high for so long. Can this individual turn glucose into ATP? Can we actually make fuel from this? We're hybrid engines basically, right? We can flip back and forth between burning sugar for fuel and burning fat for fuel. And for many people, pretty much all of us, regardless of diabetes status, as we age, we become more insulin resistant and also less efficient at turning glucose into ATP or fuel. And so the brilliance of the system, this design, divine design, is that we can just switch, we can switch to burning ketones or fat for fuel and then burn that more cleanly. It creates less oxidative stress, it's detoxifying, it's anti inflammatory and it gives us that resource. So the brain uses 20% of the energy expenditure every day in our body, only makes up 2% of our body weight. So the brain is extremely, extremely hungry. And then when you add toxic burden, infectious burden, now we need even more resource because we've got to. We've got to resolve those things.

So we've talked about the impact of glucose and how we're less efficient over time. And you drew the link between glucose and then switching over to an organic ketogenic diet. And then you alluded to at Marama that people are doing a lot of movement. Why? What's the data on this? Why does it matter? Talk to me about that.

I mean, exercise is better than any medication on the market, right? For pretty much all complex chronic disease, the connection between brain health and heart health is really the common denominator. There is plumbing. We've got to be able to get blood around the body to the brain, get it out, in and out. We've got to deliver oxygen and nutrients for our cells to function, whether they're in our heart or in our brain. And then in between, that endothelial lining needs to function, right? It can't be full of plaques and atherosclerotic plaques. It can't be inflamed because then we're not going to deliver that nutrients, right? So we. Exercise is one of the best ways to get at both of these. Sleep is often better when we get exercise. And sleep is crucial to brain health because in deep sleep, that's when we rinse, we get that glymphatic rinsing where that's when the amyloid plaques come. It's also when that daily metabolic waste that every neuron creates comes out of the system. It's when we get rid of the mercury that might have accumulated from that fish we ate. And then during REM sleep, that rapid eye movement sleep, that's when we consolidate memories. That's when we take the emotional charge out of that thing that happened the other day. And so we need both of these components of sleep, that deep sleep, that REM sleep. We need good quality sleep, not just enough sleep, but good quality sleep for our brain health. And exercise. Exercise helps us to get that. So exercise is just a crucial component to a brain, healthy lifestyle. But one thing that many people haven't heard of is dual task exercise. A lot of people are familiar with aerobic exercise or strength training. Dual task is when you combine cognitive and physical exercise at the same time, and you actually get more benefit cognitively when you do this. So for every minute you spend exercising, if you can be engaged cognitively, you're going to get more benefit.

Wait, no, wait, wait. Okay, so I go to the gym, I Go to the treadmill and I walk on the treadmill and I bring my Kindle. Okay. I'm like, multitasking. I have my earbuds in to listen to music and I'm reading my book. Is. Are you telling me that what I'm doing is good? Yes, because I know people would be like, wendy, you need to, like, amp up your intensity and stop reading the book. But I'm like, I like reading the book and it gets me distracted. So you're telling me that's okay. I. I've been blessed.

Yeah. What you want to do is be basically at like 70, 80% of cognitive and physical capacity.

Nothing here at 80.

I don't know that I ever get 80.

I don't. You don't want to be checked out or like cruising.

Right.

You want to. There. You do need some degree of intensity. So the way I describe this, like, walking and talking is the simplest form of dual task. But for you guys, that's probably not enough. Right. We've got to be going to. One of my favorites is dance class. Right. A Zumba class, a ballroom dance class, a hip hop class, whatever you want. But even yoga and Pilates, when you're physically and cognitively engaged because you're being cued by an instructor or you need to stay cognizant to the music or your partner, that's a phenomenal way to do this. Or pickleball. There's that big pickleball fad these days. And this is so great because you're socially engaged. There's strategy involved, there's hand eye coordination involved, you're often outside. It's new to many people, so they're having to learn a new game. And it's physically, especially if you're a little competitive, it makes you work. And so you're aerobically, really, you're challenged typically. And this is, this is just pretty ideal for a lot of people who are in those earlier stages or, you know, like in middle age. So there's a lot of different ways to do it. There's. We often in our coaching groups will brainstorm, what does this mean for you? And it's dynamic, Right. For you. As you become more, you know, you have more capacity, you become more conditioned physically. You need to up the ante.

If you ever talked to Ari Whitten, who, I think last time I spoke with him was living in Costa Rica, and every day he spends like four to six hours, four to six hours doing something. And he's all about energy and brain function and recovery and he spends 46 hours, but it's different every day. So one day he goes rock climbing, and another day he goes and does like, paragliding and sailing. And like, he does something every day for, but for multiple hours. And his whole belief is we need to make the mitochondria more robust. And if you do the same thing over and over, you get muscle memory, which is good, except then you stop growing and so doing new things and challenging the system. Exactly what you're talking about. That you're going to build your mitochondria that way.

Yeah, Your mitochondria, your neurons. I mean, everything.

I want to touch on one thing that you, that both of you have said that I really want to kind of even further emphasize. How many people do we see that at 60 or 50? When I, when I see them, at least they say, yeah, I exercise five days a week, I walk for a mile. And that's, that's okay. But when you look back, they were athletes, they exercised a lot, etcetera, so forth. And then they, by the time they're 40, 50, 60, it's okay just to walk for exercise. And what you're really saying is, no, you really need to get the heart pumping. Walking is amazing, but. And should be part of that routine, but it's just not enough.

There was a study out of the UK just a couple years ago, it was around December, I think, 2021, and it showed, it really validated this idea of 10,000 steps a day, that if you are in middle age and you don't have dementia yet, you cut your dementia risk in half when you walk. It was like 9,800 steps per day. And so that 10,000 steps a day is a great goal. But if we already are in that cognitive decline state, walking is not enough. We are asking for a miracle. We are asking to reverse the progression towards dementia. And that means we've got to do more. We've got to be willing to make bigger changes.

Now I want to go back to. You were talking about deep sleep. And I remember when I learned that when you hit deep sleep, the highway in your brain gets bigger, so the cells shrink, the distance between them gets greater, and then you can get that drainage path way going. I remember learning that being like, are you kidding me? Like, like, just, just. That's fascinating. Just by getting deep sleep, you go, you get the, the glymph going and you get the drainage going and you start to detox. So if you're someone who's not sleeping, you need to get deep Sleep so that you can actually preserve your brain health. It's fascinating.

And do you go, why did I have all those babies? Because they robbed me of that deep sleep for years.

My God. Right? I remember craving unbroken sleep. Like, I just want to sleep through the night, please.

Yeah. That being said, though, how many women, postmenopausal women, have trouble sleeping, though, that we see all the time.

Yeah. Well, which is why when, you know, you walk in, we're like, let's check your hormones.

Let's look at that. And why so many people tell me progesterone is my new best friend.

Seriously, man, I love progesterone. We'll talk about that in another conversation. Okay. So we've talked about keto.

Hormones are a piece of this.

Hormones are. They're one major part. Your endocrine system for Alzheimer's.

Absolutely, absolutely. You know, thyroid, vitamin D, our bdnf, brain derived nootropic factor, is a signaling. And again, so we mentioned exercise and I talked about dual task, but aerobic and strength are both really important. And bdnf, brain derived nootropic factor, which is a signal that goes to your brain, comes from muscle. And so you can drink mushroom teas and do nootropic supplements and stuff, but muscle is a great way to get both testosterone and BDNF to your brain. And so we don't want, want to skip out on, you know, if we're doing dual task, do some of it with your strength training and some with your aerobic training. But yeah, the hormones, the signals that go to our brain, we want to make sure that those signals are stacked so that they tell the brain to create new neurons, new connections between those neurons. Synaptogenesis and neurogenesis is what we're after. And there's lots of ways to do that. And you want to make sure that you've kind of got them all covered because it's something we have control over. We can use the hormone replacement therapy, but pregnenolone, dhea, these are available over the count. Encounter BDNF exercise. There's lots of ways to create these signals. And then not skipping out on the vitamin D and the thyroid optimization, I'm.

So present to Heather that you're. What you're really highlighting is that you're either growing and developing and getting healthier, or you're backsliding and shrinking and that, you know, it's almost like this whole philosophy of we need to expand because otherwise we will die off and we just need to keep growing you know.

Dr. Bredesen has this phenomenal analogy that really struck me when he said it. He's like, think of your brain like a country, my brain a stone. And if that brain is like Ukraine, right. If you are fighting a war, if you are attacking and defending against invaders of toxins or infections, then you are not. You should not be building roads in schools. Right? Right.

You.

You should not be building new neurons and new connections between them. You should not be focused on infrastructure because it might just get destroyed.

Right.

And you need that resource. You need that resource to finish the job. So, yes, we. We often will do all of these things at once if someone has Alzheimer's. But I think that if you are in the luxurious state of not having dementia, of, in being in prevention mode, then, yeah, if you defend, attack, finish that job, do the detox, get on the hormone supplementation, get on, get the nutrients balanced, finish that work. And then, you know, there's the things like stem cells and peptides and that regenerative stuff that we can focus on. But I. I do think that you're absolutely right. You're either, you're either shrinking and defending and getting smaller, or you're going in that direction of regeneration.

You haven't talked about stress at all. Heather, can you touch on that? Because I feel like out of all of the things that we've talked about stress, you've probably heard me just say, like, sugar's the devil, alcohol is the devil. But I think really, stress is the devil, when we get down to it, that it's the thing that throws, you know, because your cognitive function can be impaired when you're stressed. So talk to me about where does that fall and how do people deal with it?

Absolutely. I mean, this is why torture doesn't work, right? It's because we've all been in that super stressful situation, maybe public speaking or whatever it is, and we can't remember, right? Stage fright, that's what it is. And we've all been sleep deprived and not been able to remember. So I think just backing up real quick to say, how do we organize ourselves so when we think about imbalance, Too much, too little in the wrong place at the wrong time. And then for the brain, we apply this to six different categories. Toxins, nutrients. So imbalances and toxins. And too many, too little in the wrong place at the wrong time. Imbalances in nutrients, imbalances in structure, imbalances in stress. Stress imbalances when it comes to infections and imbalances when it comes to Signaling. So we chatted about signaling. We've talked about a few of these pieces. But just to kind of give us this framework, where does that fit in? Because it's going to be stress for one person, it's going to be toxins for another person, it's going to be traumatic brain injuries for another person, or it's going to be all of those things. Right. And so for each person, what's paramount? Well, we have to systematically kind of go through and ask the questions and decide together with a provider, hopefully. And then women start in this place where we're going to get the biggest kind of bang for our buck. Right. So stress is a huge one, particularly for caregivers. Many people don't realize someone caring for someone with dementia has anywhere from two and a half to six times the risk of being diagnosed with dementia later on in life.

So basically, if my husband got dementia, he'd be going into a nursing home. Is that. Is that just what I heard you say?

Did I just give you permission to put Ed in a nursing home?

Well.

Actually, here's the problem, Wendy, is that men who are the. The spouses of a female with dementia are the ones that have the 6x risk. So really, I just gave Ed's permission.

Well, there we go. Sorry.

Okay, well, you can put me in a home, honey. Feed me gluten. I'll be gone really fast. You know, like, let's just not prolong this. Just give me gluten, I'll go, and we'd be done.

Well, at least you guys have four kids, so I'm sure at least one of them is going to show up fully for you guys and, and take really good care of you.

Right?

Do you know which one?

We'll see about that.

I don't want to poison the well, so we'll just pause. Okay. But what you've also highlighted is this is not the kind of thing that you're going to do alone. There's a lot of things you can do on your own. But if you are concerned that you've tipped from, hey, I'm just perimenopausal, I have low testosterone into. I really clearly see something's not right. That's when you're going to want to get an evaluation. But then what are the things people can do? Because there's so. It's the things we've even touched on. There's so many things people can do to take back the agency in control of their future. So can you just list out three to five things, like you know, you kind of touched on them, but. But let's really nail it home.

Yeah. So what we recommend people do is start with what's easiest or with what's going to make the biggest difference. So if you know that you are a total stress case and that cortisol is coursing through your brain and it's, you know, it's toxic to your hippocampus, then start a meditation practice or a daily prayer practice. Do something that's going to help you manage your stressors. Start going to church, if that's what that means for you. Do what is necessary for you to get that. Because stress, it's an experience. Right. And we have control over how we experience stress. So the key is to change our experience of it. We've all seen those people that have been through extremely stressful experiences. Some of them come out doing really well. They'll be better because of it. And others turn gray. And it looks. Looks like, you know, they're on their deathbed because of it. So we, we want to be that person where it makes us better. We want to transform our experience of stress. And then what we want to do, that's. That's stress. But I really think. And this is why I wrote the book, because I. Three or four things. Yeah. Get on an organic ketogenic diet, prioritize your sleep, and get a sleep study if you have any cognitive decline because sleep apnea must be treated. Start a meditation or daily prayer practice, and start getting exercise, dual task exercise. Those are four things that you can do that everybod can benefit. They're foundational. And then in the book, we basically take you through. All right, which one applies to me, we ask some questions. We get specific about if you're not having a bowel movement every day, that's the place to start because you're clearly not getting the toxins out. But that doesn't apply to everyone. Right. So it's important to. And we need to be precise. This is the. You know, we're at a time when we have technology, we have great providers. There's more than 2,000 trained by Dr. Bredesen. You guys are in the functional medicine community. There are thousands of doctors that have been trained that way. Find someone, put the data to work and understand what's going on for you so that you can optimize this process.

Yeah, I mean, this is highly personalized. When we do this, we're really look. And it's a very large evaluation. Sometimes it's a.

It's.

And I I don't know if you tend to do this, but typically I'm working on the foundations, like the things you said. Eat, sleep, move, think, breathe, connect. Those are your foundations. And then we're going to look at what's happening in your gut, your adrenals, your liver, your minerals, nutrients, your hormones, your endocrine system. And then we're going to look at what's happening with your toxins and your exposures and your home and your thoughts and all of it. So it really is like a build on the past information, but it's a big, it's a big chew bite, but it's very rewarding to watch. It works.

It works, it works. The medicine works, the lifestyle works. And unfortunately there is not a pharmaceutical solution. Memantine or Namenda, Aricept or Genepsil. These are medications that work on the neurotransmitters. And sometimes we'll see for three months or so people will get a little bit better. But five years later, there's a JAMA article, Journal of the American Medical association, that showed that five years later, people who got on those medications did worse than people who never started them. They don't help long term. I had a 95 year old patient recently. He's like, I'll just get on him because I'm not planning to be here in five years. I was, fair enough.

I mean, you know, it's interesting you say that because it, it almost feels like if you're on a medication, then maybe there's not as much pressure or onus or, or drive to make sure that you're on an organic ketogenic diet, that you're moving your body in the, what did you call it?

The, the buy the dual task.

Dual task. Thank you. So that you're doing that, that you're starting. Oh, please. I'm, I'm, I'm already like, I think I need to go on that organic ketogenic diet. If gluten free, that's automatically gluten free. It's a great way to eat. So I think you're just, it almost feels like if you're on a medication, maybe you don't need to take as much. Focus on the foundational things because you're like, well, I'm on this medication. Except the medication I feel like I read in Bren's book, I feel like I read this, that, that essentially these medications, if you have a leaky roof, this medication is putting a bucket under one leak, but you still have 27 other leaks going on. And, and so you're only catching one, so you don't see the. It's like sitting on 10 tacks. If you take one away, it's big difference. Take eight away, nine away. Then you're like, oh, now I'm getting better. So it's. It's a multifocal approach.

Precisely. Yeah. And, you know, with the. The medications, you're absolutely right. There's sort of this perspective shift of like, I can rely on something else to fix me. Someone else. Something else. And I wish it worked like that. Right. If there were a magic pill or an IV That I could give people to make the suffering associated with dementia go away, I would be screaming it from the room. I would be the biggest fan of that because I've personally watched so many people go down this path. And it's like I said, it's just bankrupting physically, emotionally, financially. It's so hard. And so the gift, I think, in this, what we're trying to say is, like, you don't have to accept that. And that's not gonna be for everyone because it requires work. It's not easy, it's not free. It requires work and resources. But it leads to a more fulfilling, more rewarding life in that last phase. And so, you know, I think it's worth it. But not everybody's gonna come to that conclusion, and that's up to them. The only crime is when they don't know that there's an option.

So where can people find you? I know. First off, go buy the book. Is it on Amazon? Where's the book?

Wherever you find books. You know, we. We love supporting independent bookstores where. But wherever you find books, please get. Get a book, write a review, tell us what, and then feel free to join the community@doctorheathersandison.com My last name is spelled S A N D I s o n. Doctorheathersandison.com and you can sign up for my email list, learn about, you know, our perspectives on new research that's coming out, new offerings, new things that are happening at Marama and at our clinic. We are looking to create more research opportunities for people to get involved in as. As participants in research trials. So really exciting stuff on the horizon, and I just want everybody to have all of the tools, that toolkit, so that they can optimize cognition wherever they are in the spectrum.

Amazing.

Just amazing.

It is. Heather, thank you. So. So I think what you left us with is a message of hope, and so get the book. Check out Dr. Heathersanderson.com. we'll put that link in the in the show notes. And then to all the listeners, don't give up. Right? You can alter your future. And it starts now. So thanks, Heather, for being here. You're an awesome guest. I love hanging out with you. And to the listeners, thanks for joining us for another episode of the Feel Freaking Amazing podcast. I'm Wendy Trubo at Levitan and we'll see you again soon. Thanks, Heather.

Thanks you guys. Be well.

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